Use of infertility services in the United States: 1995.

CONTEXT: Both the demand for and the availability of infertility services in the United States increased during the 1980s and early 1990s. Understanding the factors that are related to service-seeking among women with current fertility problems would aid efforts to better provide services. METHODOLOGY: Data on U.S. women's use of infertility services were taken from the 1995 National Survey of Family Growth, a nationally representative survey of 10,847 women aged 15-44. For the 1,210 women who at the time of the interview reported having fertility problems, multivariate statistical modeling was used to identify the characteristics associated with their use of infertility services. RESULTS: Of the 6.7 million women with fertility problems in 1995, 42% had received some form of infertility services. The most common services ever received among these women were advice (60%) and diagnostic tests (50%), medical help to prevent miscarriage (44%) and drugs to induce ovulation (35%). The proportions of fertility-impaired women who had ever received infertility services were generally highest among those who were older, who had ever been married, who had graduated from college, who had a high income and who were non-Hispanic white. Multivariate analyses reveal that apparent differences by age and race or ethnicity in the unadjusted analysis disappear once the effects of women's marital status, income and private health insurance coverage are taken into account. CONCLUSION: Women who have ever used infertility services continue to represent a select group from among those with impaired fertility. Moreover, the vast majority of women with fertility problems who seek services receive noninvasive treatments that could be considered "low technology" interventions.

Updated projections of infertility in the United States: 1995-2025.

OBJECTIVE: To project the number of infertile women aged 15-44 every 5 years from 2000 to 2025. DESIGN: Data are used from Cycle 5 of the National Survey of Family Growth conducted by the National Center for Health Statistics. Population projections prepared by the U.S. Bureau of the Census are used as the base population for 2000-2025. Prospective demographic projections are used to estimate the number of infertile women. PARTICIPANTS: The National Survey of Family Growth (Cycle 5) interviewed 10,847 women aged 15-44 in 1995. MAIN OUTCOME MEASURE(S): Number of infertile women. RESULT(S): The number of women experiencing infertility will range from 5.4-7.7 million in 2025, with the most likely number to be just under 6.5 million. CONCLUSION(S): This is a substantial revision (upward) in the number of infertile women, largely a result of the increase in the observed percentage of infertile women in 1995. This is the base population of concern to providers; of particular interest is the percentage of infertile women who seek medical treatment.

Impaired fecundity in the United States: 1982-1995.

CONTEXT: The 1995 National Survey of Family Growth (NSFG) provides new nationally representative data to test the accuracy of the commonly held assumption that impaired fecundity has been rising in the United States over the past decade. METHODS: Using data from the 1982, 1988 and 1995 rounds of the NSFG, trends in both the proportions and numbers of women with impaired fecundity and of those who received infertility services were examined. Multiple logistic regressions were carried out to estimate the effects of demographic characteristics on the likelihood of currently having impaired fecundity and of ever having received medical help for infertility. RESULTS: The proportion of U.S. women aged 15-44 who reported some form of fecundity impairment rose from 8% in 1982 and 1988 to 10% in 1995, an increase in absolute numbers from 4.6 million to 6.2 million women. Although the proportion of fecundity-impaired women who had ever sought medical help did not change between 1988 and 1995 (44%), the absolute numbers of such women grew by nearly 30%, from 2.1 million to 2.7 million. Women who had ever sought help for fertility problems were older and had a higher income than those who had not, and were more likely to be married. CONCLUSION: The dramatic increase in the numbers of U.S. women with impaired fecundity occurred because the large baby-boom cohort, many of whom delayed childbearing, had reached their later and less fecund reproductive years. This increase in both rates and numbers occurred across almost all age, parity, marital status, education, income, and race and ethnicity subgroups.

Projections of impaired fecundity among women in the United States: 1995 to 2020.

OBJECTIVE: To determine the number of women aged 15 to 44 years with impaired fecundity every 5 years from 1995 to 2020. DESIGN: Data are used from cycle IV of the National Survey of Family Growth conducted by the National Center for Health Statistics. Population projections prepared by the U.S. Census Bureau are used for the expected population base for 1995 to 2020. Prospective demographic projection analysis is used to estimate the number of women with impaired fecundity. PARTICIPANTS: The National Survey of Family Growth interviewed 8,450 women aged 15 to 44 years as of March 15, 1988. MAIN OUTCOME MEASURE: Number of women with impaired fecundity. RESULTS: The number of women with impaired fecundity may drop from 5.1 million in 1995 to 4.7 million in 2015 and then rise to 4.8 to 5.9 million in 2020. CONCLUSION: The age structure of the population will cause the absolute number of women with impaired fecundity in the United States to increase slowly, if at all, over the next 25 years.

Health of the foreign-born population: United States, 1989-90.

The health status of immigrants is of vital interest to health policy planners as the number of immigrants in the United States increases. This report has shown that, overall, foreign-born persons had better health than the U.S.-born population, although this health advantage varied by length of residence in the United States. In virtually every measure of health status, and with regard to almost every sociodemographic characteristic, the most recent immigrants were healthier than foreign-born persons who have lived in the United States 10 years or more as well as healthier than the U.S.-born population. Immigrants who had lived in the United States 10 years or longer were generally healthier than U.S.-born adults, although the differences were not as striking as between recent immigrants and the native-born population. These findings may be explained in several ways. First, recent cohorts of immigrants may have been healthier than earlier cohorts of immigrants at the time of immigration. If so, as their duration of residence in the United States increases, they will continue to be significantly healthier than native-born persons. Second, earlier cohorts of immigrants may have been as healthy as recent cohorts at the time of immigration, but their health has deteriorated with increased duration of residence in the United States. This suggests that immigrants had or acquired physical conditions or behaviors that put them at risk in their new environment or that access to health care has been limited. It also suggests that more recent cohorts of immigrants could experience a similar deterioration of health as their duration of residence in the United States increases. Finally, these findings may reflect a combination of these influences or other factors not considered. To understand these patterns will require additional research, including comparative studies of the health of immigrants in the United States with the health of nonmigrants (stayers) in the countries of immigrant origin.

Intergenerational transfers: a question of perspective.

Informal intergenerational transfers have traditionally been examined from the perspective of the older generation; more recent studies have proceeded from the perspective of adult children. Drawing upon principles of formal demography, we establish the mathematical relationship between the two generations' perspectives. We then consider the importance of generational perspective with regard to prevalence estimates of intrafamily transfers. Transfers examined include coresidence, household and financial assistance, and personal caregiving. Results have implications for projection of future trends in intrafamily transfers and for data collection.

Language usage and fertility in the Mexican-origin population of the United States.

This article examines the effects of English proficiency and female education on cumulative and recent fertility within the Mexican-origin population in the U.S. To ascertain whether the cultural or the human capital aspects of linguistic variables have the greater salience for fertility behavior, fertility patterns of bilingual women are compared with those of monolingual women speaking English or Spanish. Using the 1980 U.S. Census 5 percent Public Use Microdata Sample for ever-married Mexican-origin women aged 15-44, we find that for almost all age cohorts, the effects of English proficiency are negative and increase with rising education. The strength of the interaction is greater in younger age groups. Greater English proficiency is also associated with a more negative impact of education for native- than foreign-born women. Overall, the influence of "opportunity cost," as opposed to cultural factors, is more important in shaping the fertility behavior of these women.

Racial differences in contraceptive choice: complexity and implications.

Previous research has failed to generate consensus about why black fertility has persistently exceeded that of whites in the United States. In an effort to shed light on this question, this article examines black/white differences in sociodemographic factors affecting contraceptive choice. Using data from the 1976 and 1982 National Surveys of Family Growth, we find a complex pattern of black/white differences. Not only does contraceptive choice vary by race, but the effects of such variables as age, marital status, and education also differ between blacks and whites. For example, compared with whites, black married women avoid coital methods, and compared with blacks, white women shift contraceptive behavior more as they change marital status. The complex nature of the racial differences in contraceptive choice are interpreted as reflecting differences in marriage patterns and trends.